Spinal Disc Herniation
Spinal disc herniation is an injury that occurs to the cushioning and connective tissue between vertebrae, that occurs due to severe pressure to the spine. It may cause pain along the body and physical disability. The most commonly used tool to diagnose spinal disc herniation is MRI and painkillers or surgery is used to treat it.
When the intervertebral disc suffers a tear in the outer ring, the soft central portion falls out far than the damaged outer rings, and the disc is known to be herniated. Disc herniation usually happens with age-related degeneration of the outer ring, called as annulus fibrosus and is usually caused by trauma (from twisting of lifting). As the disc tears, chemicals are released that cause inflammation and this causes extreme pain even in the absence of nerve root compression.
Disc herniation was known as disc protrusion before and in this, the outermost layers of the annulus fibrosus are in order but they can move when the disc faces pressure. Usually, minor herniation heals within some weeks. Treatments that reduce inflammation can be effective however severe herniation may ask for surgery.
Signs and Symptoms
Usually, symptoms occur on one side of the body.
The symptoms of a herniated disc are varying as they depend on the herniation and the soft tissues that are under the subject. If the disc is the only tissue that has been harmed, there may be little to no pain however if the nerve roots are damaged then extreme neck or low back pain can occur. Usually, herniated discs are not known immediately.
There may be a number of symptoms like numbness, tingling, paresthesia, and weakness in muscles along with paralysis, affection of reflexes. If the disc herniated in the lumbar region then sciatica may be observed by the patient. The pain that arises from a herniated disc is unending and it usually happens in a certain part of the body.
However, there may be no pain if the extruded nucleus pulposus material has not pressed on soft tissues or nerves but the disc may still be herniated. A study has proved this.
A herniated disc may send nerve pain to the lower part of the body or groin area and may also be related to bowel or bladder incontinence.
Usually, pain occurs on one side of the body however, if a herniation is extreme and affects the cauda equina then both sides of the body may be in pain. This can cause permanent nerve damage or even paralysis making the patient lose sexual functions and loss of bowel and bladder controls.
When a person is standing or lying down the spine is straight and the pressure within is divided equally but while sitting or bending or lifting, the pressure can move to 300 psi. Herniation of the disc usually happens when the stomach side of the disc is pressured while sitting or bending forward and the disc is pressured from inside. The stretching and increased internal pressure may rupture the confining membrane. The liquid-like contents of the disc sway into the spinal canal and they press against the spinal nerves and this can generate excruciating pain.
It is believed by some authors that the degeneration of the intervertebral disc causes spinal disc herniation (mostly) and trauma is a minor cause. The degeneration of the disc happens both in raging and degenerative disc disease. With degeneration, the components of the disc are exposed to exterior loads and since it cannot handle the pressure, fissures are created.
There are many genes that have been credited to intervertebral disc degeneration. When the genes MMP2 and THBS2 become mutated, lumbar disc herniation can be caused.
Mostly, athletes are prone to disc herniations. They can happen due to wear and tear, quick bending or heavy impacts.
Most spinal disc herniations happen in the lumbar spine whereas the next is the cervical region. Herniations mostly happen where the annulus fibrosus is thin and is not backed up by anterior longitudinal ligament.
Lumbar disc herniations happen in the back, usually near the 4th and 5th lumbar vertebral bodies. Symptoms can be observed in the lower back, buttocks, thighs, anal/genital region and may reach the toe. The sciatic and femoral nerves can be affected where different types of symptoms occur.
Cervical Disc herniation
These happen in the neck, between the 5th and 6th and the 7th cervical vertebral bodies. It is most common in 60+ patients and symptoms can be observed along the neck, skull (back), shoulder, arm, hand.
Intradural disc herniation
A not common form of disc herniation, it requires pre-operative imaging to be diagnosed.
Disc herniation can also be caused by inflammation; this is suggested by the evidence. Tumor necrosis factor-alpha (TNF-alpha) is released in these scenarios and this causes extreme pain.
Slipped disc, ruptured disc, herniated disc, prolapsed disc these terms are used to describe the underlying condition. There are other terms as well.
The most popular term, however, is a misnomer when the intervertebral discs are closely held and they cannot come out of place. The disc can go out of proportion in fewer degrees and it can also be torn, ripped, herniated but not slipped.
Spinal disc herniation is also known as prolapsus disci interverebralis.
A practitioner, based on medical history and physical examination can evaluate along with tests to confirm and compare the symptoms.
Straight leg raise
Used as a preliminary test to see disc herniation in the lumbar region. The patient is asked to lift one leg while they are sitting.
- Projectional radiography. Even though x-rays are limited, they are used to rule out tumors, infections, fractures.
- Computed tomography scan is a diagnostic image generated to display the spinal canal and all around it.
- Magnetic resonance imaging (MRI) generates 3D images of body structures using magnets and computers. It provides valuable evidence to diagnose disc herniation.
- Myelography is an x-ray of the spinal canal when a material is injected to show contrasting material. It displays herniated discs, tumors, bone spurs.
- Electromyography and nerve conduction studies. These test electrical impulses along with the nerve roots, peripheral nerves, and the muscle tissue. It can show nerve damage and compressions in nerves.
There are many tests done to find out which disc herniation is in order.
In most cases, spinal disc herniation can be fixed without the herniated material being removed by surgery. Patients that have problems with Sciatica (symptoms) recover rather quickly.
In the starting, nonsteroidal anti-inflammatory drugs are used but overuse may make things difficult.
Epidural Corticosteroid injections can make things better in the short-run with sciatica. FDA said that this injection in the spine may cause rare problems such as stroke or death.
Lumbar disc herniation
Methods that are non-surgical are tried first. Medications may be given to treat acute pain and for the patient to relax.
- Physical therapy to relieve pain (temporarily)
- Control of weight
- Non-steroidal anti-inflammatory drugs
- Spinal manipulation. This is more effective compared to other methods to treat lumbar disc herniation. In 2006, a review concluded that spinal manipulation is safe when it is conducted by a trained practitioner.
- Spinal manipulation is contraindicated for disc herniations in cases of cauda equine syndrome.
- Studies say that there is minimal evidence that shows the effectiveness of non-surgical spinal decompression therapy.
When a herniated disc is causing excruciating pain and the pain is reaching to other parts of the body, surgery may be needed.
- Discectomy – partial removing of a disc that gives leg pain
- Small endoscopic discectomy—non-evasive
- Invasive microdiscectomy—one-inch skin is opened is not so different than large-skin opening excluding the infection part.
- Failed back syndrome—invasive spine surgery treats disc herniation.
- Cauda equina syndrome—requires immediate medical attention and surgery
The two most common forms are lumbar disc herniation and cervical disc herniation. Lumbar disc occurs more often and it is often the cause of lower back pain. Places like upper two cervical intervertebral spaces, the sacrum, and coccyx are not included as being risky as they have no discs. As a person ages, the chance of herniation falls as the nucleus pulposus changes (dries out) and in this case, spinal stenosis is usually the cause of back/leg pain.
Biomechanics face the most back injuries and prevention can come from educating them, training them in physical fitness and proper body mechanics.
Educating people not to lift more than their capability and letting the body rest after work. Poor posture, in the long run, can make matters worse. Posture should be maintained and body alignment will prevent disc degradation.
Exercises that strengthen the back can be used to prevent back injuries. Prone press-ups, upper back extension, transverse abdominis bracing and floor bridges are common exercises that can be used. Moreover, weight loss can help but you should not work beyond capability. If symptoms of fatigue start to appear, rest is mandatory. In heavy lifting, the legs should do most of the work, not the back. Swimming also strains the back and support belts during lifting.